The objectives of this proposed follow-up study of automated ambulatory medical record systems (AAMRS) are (1) to determine whether the findings and conclusions of a 1974-1975 AAMRS study are still valid, or whether the field has progressed in ways that may have a significant impact on the design and implementation of future AAMRS; and (2) to prepare a final report suitable for wide public dissemination that incorporates the findings and conclusions of the 1974-1975 study and indicates how the field has progressed in the past five years. To permit a longitudinal comparison between the 17 sites that were visited in the 1974-1975 study and the current status of these sites, the follow-up study will use the same methodological approach as the 1974-1975 study. A multidisciplinary site visit team will be used to visit about five of the sites visited in 1974-1975. The strategy will be to select those sites that appear to have made progress in breadth of operations or incorporated important innovations since 1975. The same model for inquiry and interview guides developed for the 1974-1975 study will be used. Individual site visit reports will be prepared and submitted to the site for review and confirmation. Updated information on the other AAMRS sites visited in 1974-1975 will be solicited by mail. The AAMRS literature review relating to the sites visited in 1974-1975 will be updated. A final report suitable for publication will be prepared; this report will synthesize the findings from the 1974-1975 and follow-up studies, and present the conclusions of the study team. The study team will consist of five persons, of whom four were members of the original study team. This team will represent the disciplines of medicine, medical information systems, health economics, and evaluation methodology.